The present invention relates generally to orthopedic instrumentation, systems, kits and methods for repairing soft tissue injuries including positioning and securing a graft, such as for use in reconstructing soft tissue in a joint between bones of a patient. More specifically, the present invention relates to the positioning and securing of tendon and/or ligament grafts, and more particularly, for example, the positioning and securing of an anterior cruciate ligament (ACL) graft in the knee joint of a patient.
ACL injuries are often caused by a sudden force applied to the knee, and are a common form of injury suffered during athletic activities. The injury occurs typically when the knee is bent or twisted in an awkward direction.
Current surgical reconstruction of ACL injuries may be arthroscopic or open and commonly include the formation of two bone tunnels, one in the tibia and one in the femur, which serve as attachment points for a graft. A replacement graft, either of natural tissue or artificial materials, is typically used to replace the damaged, native soft tissue as such replacement typically has better results than attempting to repair and reuse the native tissue. In any event, commonly, the native soft tissue has extensive damage, thus limiting its usefulness, and thus is likely to be removed and replaced by a graft.
Positioning and securing a graft in a prepared bone bore hole is a typical method of performing a soft tissue repair. In a specific soft tissue repair, such as in ACL repair, it is common to use a suture to pull the graft into the bone tunnel, and the graft is then secured within the bone tunnel using a suture button and/or an interference screw. A similar method and instrumentation is employed to secure the graft in the tibial bone tunnel.
However, such methods of securing the graft have various drawbacks. For example, positioning the interference screw into the bone tunnel, and adjacent the graft, could result in damage to the graft through contact with the interference screw along a portion of the graft other than the area where the interference screw is intended to create the fixation.
Further, traditional instrumentation, such as rigid and linear instrumentation, can result in limited access to the native insertion site of the ACL, thus requiring that the knee undergo hyperflexion in order for such instrumentation to access the native site. Accessing the native site can be important to the success of the repair. Recently, instrumentation capable of flexing and navigating curved access pathways has been introduced for the repair of damaged tissue such as the ACL, labrum, or the like, including commercial products such as the VersiTomic™ Flexible Reaming System and the TwinLoop FLEX™ Instrumentation System (both manufactured by Howmedica Osteonics Corp., Mahwah, N.J.). Such systems utilize instruments having shafts that include a flexible portion, such as on a drill shaft or the like, to achieve better access to preferred positions for the placement of bone holes and bone tunnels, soft tissue connection sites, and the like. For example, such flexible instrumentation can place a bone tunnel at the native insertion site of the ACL on the femur while allowing the knee joint to remain at a normal angle rather than in hyperflexion.
There is an increased need for further instrumentation that can achieve increased success in soft tissue repair, and particularly in ACL repair.